Dysfunctional uterine bleeding as an early sign of polycystic ovary syndrome during adolescence: an update

Division of Pediatric-Adolescent Gynecology and Reconstructive Surgery, Second Department of Obstetrics and Gynecology, National and Kapodistrian University of Athens, Medical School, Aretaieion Hospital, Athens, Greece

Abnormal uterine bleeding (AUB) is a frequent reason for concern between adolescents. The most common cause of AUB in these girls, when other pathologies have been excluded, is dysfunctional uterine bleeding (DUB). The aim of this review is to assess the role of DUB as an early symptom of polycystic ovarian syndrome (PCOS) diagnosis later in life. A review of the literature was performed, using Pubmed and Medline as primary databases, regarding the correlation between DUB cases early after menarche and PCOS diagnosis in the future. The most plausible pathophysiological mechanism in the vast majority of DUB cases is the immaturity of hypothalamic pituitary ovarian (HPO) axis. Similarities between normal changes in puberty and PCOS later in life such as: increased ovarian and adrenal steroidogenesis, hyperpulsatile gonadotropin secretion, hyperinsulinemia and insulin resistance, anovulation and therefore menstrual irregularity, including DUB, have been noted in several studies. Anovulation, which can be first expressed as DUB at perimenarchal age, may persist and strengthen PCOS diagnostic criteria sometime during lifetime. Thorough attention should be paid, by specialized doctors in pediatric and adolescent gynecology, in DUB cases after menarche, while proper follow up of these girls is mandatory, due to their increased risk to manifest PCOS in the near future.